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Re: Tiny newborn too sleepy...small mouth

How did you feel about the visit? Did you feel listened to, not rushed? Does this plan make sense to you? Is it a workable schedule for you?
Did the LC offer suggestions for improving latch and positioning to improve milk transfer? Were the suggestions helpful? When do you see her again?

Speaking very generally, I think you have a workable, sensible plan here. It keeps baby on your milk, and it encourages a very frequent nursing pattern, which you want. A nipple shield is a good tool when used correctly, so as long as it is helping and you are pumping while using one until you can be sure it is not harming milk transfer or production, then a nipple shield can be very helpful.

Here is what I wonder about- the strict timing of feeds (spacing and duration) and you always giving your baby supplement after nursing. If this works for you, great. But how much are you able to adjust this schedule, if you need to, to fit you and your baby? Can you ever pump sometime that is not right after a feed? Can you nurse on cue as long as it is very frequent (12 or more times a day) and supplement with whatever you pump prior to nursing, (at least some of the time) so baby can have the experience of "finishing at the breast?" What about feeding times-must you always take baby off after 30 minutes? What if baby nurses 10 minutes one session, can baby nurse 45 the next?

And most importantly-how long must you follow this? A few days until you know baby is gaining, until baby gains birth weight back...what? Things change very quickly in the early days. Usually, for the better. So it is probably important to have some follow up contact with your LC very soon.

I hope I am not confusing you. These are questions I would ask if I were put on a schedule like this.

In other words, the plan is fine if it works for you. But if any part of it is not, I would suggest contacting your LC again and talking about it.

I also do not believe your baby is getting 'nothing' when baby nurses. The evidence suggests otherwise. One weighted feed only tells you want happened at that one feed.

Oh, and what kind of pump are you using? Are you finding the pump more effective than hand expression?

Re: Tiny newborn too sleepy...small mouth

She spent almost 3 hours with us and I definitely felt good after it. I was a little discouraged when she said the baby didn't get anything from me, because I thought we were doing good, but she also said it was just one feeding. She didn't say we have to be strict about timing but just use it as a guide. Generally she nurses for 20 minutes at a time and then falls asleep and releases the nipple, so I will stick to that. I'll pump after it if I can but she said to try and get 4 in a day. She said I shouldn't need to do this past the week as she thinks my milk will be in completely then and I can nurse only. I didn't ask about finishing at the breast but DD falls into a milk coma after we give her what I pump, so not sure she would nurse well after it but I can try. She just had a large wet diaper and her poop has changed to green, so that's good I'm guessing. I am just really worried about her weight and am trying not to freak out.

Pump wise....I have a PISA but I rented a Symphony from her and have been using that. I'll do whatever I can to get her weight back up since she is so tiny! If only she baked a little longer inside me!

Re: Tiny newborn too sleepy...small mouth

ok I am so glad you have a very good pump, and the additional details you have provided makes me think you have a very good LC too!

She just had a large wet diaper and her poop has changed to green, so that's good I'm guessing.

yes, very good!

I didn't ask about finishing at the breast but DD falls into a milk coma after we give her what I pump, so not sure she would nurse well after it but I can try.

Here is why finish at the breast may help. 1) it allows baby to equate satiety and comfort with the breast rather than the bottle(or syringe) 2)it allows mom to experience her baby experiencing satiety and comfort at the breast rather than the bottle 3) it may be helpful to supplement ahead of a feeding if baby is fussy or lacking energy.
So it is certainly not imperative, it just may be helpful. It is another tool which may or may not be helpful to you.

Try not to get discouraged. You are doing really awesome. Also do not look at baby 'gladly' taking the expressed milk in the syringe after nursing as meaning anything. For a newborn, survival depends on baby eagerly sucking/drinking anything that comes anywhere near their mouths!

Re: Tiny newborn too sleepy...small mouth

I've been pumping now since yesterday 4-5 times a day and am getting 10ml per session. Is that good output? The baby had 5 seedy poops today so I'm hoping my milk is getting better. I've noticed milk leaking from her mouth after a few feeds so I hope she is getting more from me. Do I need to add more pumping sessions in or is this good enough? I just want to nurse and not have to pump also, and this was just a temporary thing until my milk came in enough because of her weight. Also the baby is nursing a lot...like every 45 minutes sometimes but then will go 2-3 hours sleeping if I hold her in my arms. I don't let her go more than 2.5 without nursing but am wondering if the frequent nursing means that she isn't getting enough from me still. I know I am probably over thinking this...just really worried about her weight and want it back up.

Re: Tiny newborn too sleepy...small mouth

I've been pumping now since yesterday 4-5 times a day and am getting 10ml per session. Is that good output?

Is that about 1/3 of an ounce? I think that would be low-normal PUMP output for this age. Based on your baby's increasing and transitioning stools, my guess is baby is getting more than that when baby nurses. But a normal feeding this age would only be about this much to maybe up to an ounce or an ounce and a half. TINY. It often is the case that what mom pumps is less than what baby can extract. This does not mean don’t pump! Pumping is still helpful when needed even if average pump output is small.

Since your LC suggested the pumping schedule this is really a question for her. From what you are describing, I see no reason to increase pumping and you may be able to even cut back and even eliminate pumping very soon. One thing to consider is if you are still needing to use the nipple shield, it may be important to pump for a little longer. I strongly suggest call your LC about this question.

I just want to nurse and not have to pump also, and this was just a temporary thing until my milk came in enough because of her weight.

yes of course fully nursing is the goal, life gets much easier without needing to pump. I think you will be there soon.

Also the baby is nursing a lot...like every 45 minutes sometimes but then will go 2-3 hours sleeping if I hold her in my arms. I don't let her go more than 2.5 without nursing but am wondering if the frequent nursing means that she isn't getting enough from me still. I know I am probably over thinking this...just really worried about her weight and want it back up.

The frequent nursing is entirely normal. Even a full terms baby who weighs twice what your baby does would normally nurse like this. Baby wanting to nurse frequently is an excellent sign of good health and normal behavior in baby. It does not matter if baby nursed 20 minutes ago, nurse baby if baby wants. At least 10-12 times every day. More often is fine.

Re: Tiny newborn too sleepy...small mouth

Nursing is going well. I pumped last night and got close to 30 ml or half an ounce so I'm hoping my supply is going up. I also hear her swallowing more when I feed her. I am trying to wean her off the shield but the latch just isn't right because my nipple is weird on it. When I use it, I barely feel any pain but without it, I am flinching constantly. Is it bad to keep using it if my production is okay? I pumped the same amount from both breast and I see the shield full of milk when she comes off.

I have also started to get a tingling feeling in my nipples when not nursing or after it. Is that normal? I think I had trust last time, so want to avoid that as it killed me from the pain. I haven't felt a let down while feeding her so not sure what the pins and needles is. Right now it is mainly in the right side which uses the shield.

Re: Tiny newborn too sleepy...small mouth

imo it is always better to use a shield than not if the alternative is baby not being able to nurse at the breast or bad pain or injury for mom. However, it is sometimes needed for mom to pump when using one just to be sure the issues with latch that are causing the pain are not harming milk extraction which will in turn harm production over time. Are you still using the shield only on one side?

I suggest, don't worry about weaning off the shield at the moment, you have a lot on your plate. Keep working on improving latch, with your LC again if possible or some other breastfeeding helper, and occasionally try latching baby without the shield if you like.

Were you or baby given antibiotics in the hospital or after? Are you prone to yeast infections? These would make thrush more likely, but no matter what, thrush is not all that common esp this early- Nipple pain is most commonly due to latch issues. "tingling" could be other things- Healing sensations, very mild vasospasm? Again, this may be something to discuss with your IBCLC but I would not worry about it overly.

Of course your milk is increasing, the pump output increase is encouraging but the proof is in the pudding baby makes! If poops keep transitioning to very wet and loose, possibly curdy or seedy, and yellowish, and remain at 4-5 a day, (or more) that is the best indication (aside from weight gain) that all is progressing as it should.

When do you have baby weighed again-tomorrow, right? I suggest, make very sure the weight check is done very carefully. Baby should be naked. If baby poops shortly before the weight check, make note of that. Try to nurse shortly before the check. Double check the nurse's reading of the scale. Take another weight at the appt if you have any doubts.

Remember weight gain should be measured from baby's lowest known weight, NOT birth weight. It can take 10 to 14 days and sometimes longer for a health baby to regain back to birth weight.

Re: Tiny newborn too sleepy...small mouth

Oh to avoid thrush, keep 'air drying' nipples after nusring. Keep breasts uncovered as much as possible, actually. If you are using nursing pads, change frequently. If you were given anti-biotics, consider taking a probiotic. Avoid yeast triggers like sugar as much as possible. You could consider having All Purpose Nipple Ointment prescribed and made for you, I suggest, ask your LC about that.